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Flashcards in Exam 2: Respiratory Drugs Deck (54):
1

Name the types of respiratory disorders and examples of each

1. Upper Respiratory tract
a. Infections
b. Sinusitis
c. Common Cold
2. Lower Respiratory tract
a. Asthma
b. Bronchitis
c. Emphysema

2

4 Criteria for diagnosis of acute bacterial sinusitis

1. Persistent symptoms for at least 10 days without improvement
2. Severe symptoms: fever, facial pain, purulent nasal discharge for 3-4 consecutive days at beginning of illness
3. Duration of illness alone is unreliable
4. CAT scans or radiographs do not differentiate viral from bacterial sinusitis = imaging not routinely recommended

3

Most cases of acute rhinosinusitis are of what nature?

98% are viral

4

What medication may be beneficial in treating acute bacterial sinus infections

- Amoxicillin-clavulanate (Augmentin)
- If penicillin allergic, then levofloxacin or clindamycin

5

What drugs are you to avoid with bacterial sinusitis?

Avoid decongestants and antihistamines

6

Name the 4 classes of drugs for Sinusitis/Allergic Rhinitis

1. Pseudoephedrine
2. Antihistamines
3. Analgesics
4. Antibiotics (if bacterial infection)

7

Why is use of epinephrine with decongestants a concern?

These drugs are sympathomimetics and may enhance cardiac stimulation and elevate blood pressure

8

Name a new nasal aerosol corticosteroid that may treat allergic rhinitis

- QNASL Nasal Aerosol
- Beclomethasone dipropionate

9

Name Obstructive diseases and how they are defined

1. Asthma
2. COPD (chronic bronchitis, emphysema, neoplastic diseases)

10

What is the pathophysiology of Asthma

- Intermittent respiratory disorder
- Recurrent bronchial smooth muscle spasm, inflammation, swelling of bronchial mucosa, hypersecretion of mucous

11

The pathophysiology of Asthma results in what?

- Widespread narrowing of airways
- Decreased ventilation with increased airway resistance
- Decreased expiratory outflow

12

Goals of asthma therapy are to reduce what?

- Symptoms of asthma
1. Smooth muscle spasm
2. Inflammation
3. Swelling of bronchial mucosa
4. Hypersecretion of mucous

13

What is the most common form of asthma?

- Extrinsic form
- --> Inhaled seasonal allergens, pollen, dust mites, etc.
- Usually seen in children and young adults

14

What antibodies are present in Extrinsic asthma

- IgE
- Dose response relationship between allergen exposure and IgE mediated sensitization, positive skin test, family Hx

15

Intrinsic asthma is the diagnosis in approximately how many cases of asthma?

30% of cases

16

How do extrinsic and intrinsic asthma differ?

- Intrinsic
○ Seldom associated with family history of allergy
○ Patients are non-responsive to skin testing
○ Normal IgE levels
○ Middle-aged adults
- Extrinsic
- Opposite the above

17

Which form of asthma is associated with endogenous causes: Emotional stress; GERD?

Intrinsic

18

Asthmatics are more likely to have a hypersensivity reaction to what other drug?

Aspirin

19

What is the Aspiring Hypersensitivity triad?

- Aspiring hypersensitivity
- Asthma
- Nasal polyps

20

What is the mechanism of aspirin allergy and asthma?

- Inhibits bronchodilating PGE2
- Formation of leukotrienes (bronchoconstrictors)

21

What preservative can serve as a trigger to asthma?

- Sulfite preservatives
○ Cause wheezing when metabolic levels of sulfite oxidase are low
○ Sulfite dioxide is produced in absence of sulfite oxidase = precipitates acute attack

22

What age groups are most affected by exercise-induced asthma?

Children and young adults

23

What is Status Asthmaticus?

- Persistent life-threatening bronchospasm despite therapy/intervention
- Attack lasts for more than 24 hours

24

Name and describe the classifications of asthma

1. Mild
a. Symptoms only when exposed to trigger; less than twice a week
b. FEV > 80%
2. Moderate
a. More than twice a week that affect sleep and activity
b. FEV > 80%
3. Severe
a. Ongoing symptoms that limit activity
b. Frequent at night
c. FEV

25

Name the classes of medications used to treat asthma (as well as other chronic respiratory diseases)

1. Beta adrenergic stimulants
2. Steroids (adrenal glucocorticoids)
3. Leukotriene-altering medications
4. Mast cell inhibitors
5. Expectorants
6. Anti-tussive drugs

26

Medical consideration for mild intermittent asthma?

Rescue bronchodilator prn

27

Medical consideration for mild persistent asthma?

Anti-inflammatory drug with low dose inhaled corticosteroid, cromolym or anti-leukotriene

28

Medical consideration for moderate persistent asthma?

- One medium dose of inhaled corticosteroid, or two daily medications
- Low to medium dose inhaled corticosteroid and long-acting bronchodilator

29

Medical consideration for severe persistent asthma?

- Daily medications
- High-dose inhaled corticosteroid with long acting bronchodilator and oral corticosteroid

30

T or F, Asthma is undertreated

True

31

What is the preferred treatment for a mild persistant asthma according to the EPR3?

Inhaled corticosteroids

32

Use for beat adrenergic stimulants (Inhalers)

1. Reversal of airway obstruction and bronchoconstriction
2. Acute treatment of bronchospasm (asthma attack)
**Important rescue drugs for asthma

33

Mechanism of beta adrenergic stimulants

- Target beta 2 receptors in airway
**Bronchodilation

34

Name the various examples of short-acting beta adrenergic stimulants

1. Albuterol
2. Levalbuterol
3. Pirbuterol

35

What are the usage differences for short and long acting beta adrenergic stimulants?

- Short: rescue drugs
- Long: maintenance/prevention

36

Name the various examples of Long-acting beta adrenergic stimulants

1. Salmeterol (Serevent Diskus)
a. (duration 12 hours)
2. Salmeterol with fluticasone (Advair Diskus)

37

Indications for Advair Diskus

Maintenance of asthma and COPD associated with chronic bronchitis

38

Dental considerations with inhalers

1. Taste alteration
2. Oral candidiasis - Inhaled corticosteroids
3. Overuse of inhalers can lead to a hyper-reflexive airway
4. Ask patients how often they are using their rescue inhalers
a. More than once daily or two days per week suggest uncontrolled asthma
5. Tell patients to bring inhalers with them to appt

39

When might a Methylxanthine be used to treat asthma?

- Used for patients for whom newer, better asthma medications are ineffective
- Reserve drugs
- Older class of asthma drugs
- Beta adrenergic stimulant

40

Mechanism of Methylxanthines

Block phosphodiesterase which increases cAMP

41

Name the preparations of Methylxanthines

Theophylline

42

Sites of action for Methylxanthines

Bronchodilation, increased pulmonary vasodilation

43

Side effects of Methylxanthines

- Arrhythmias
- Tachycardia
- Seizures
- GI effects

44

What do Leukotrienes normally do?

Chemical mediators that produce similar effects to histamine

45

Leukotriene Drugs are primarily used for what?

Seasonal allergies

46

Name the Leukotriene drugs

- Zileutron (Zyflo)
- Zafirlukast (Accolate; Singulair)

47

Action of zileutron (Zyflo)

Inhibits the synthesis of leukotrienes

48

Action of zafirlukast (Singulair)

Blocks leukotriene receptors

49

What are the drugs of choice for reducing inflammation?

Steroids

50

Use of Steroids in respiratory problems

- Inflammation
- Decrease frequency and severity of asthma attacks

51

Mechanism of Steroids in respiratory problems

- Reduced cytokine production
- Inhibition of accumulation of basophils, eosinophils and leukocytes

52

Preparation types of steroids used for respiratory problems

- Intranasal, inhaled and systemic

53

Which steroid was switched from Prescription to OTC?

- Nasacort
- First OTC intranasal steroid

54

Dental considerations with Steroids

1. Oral candidiasis
2. Susceptibility to infection
3. Delayed wound healing
4. Adrenal suppresion